Medically ready for discharge: A multisite “point-in-time” assessment of hospitalized patients

Background: Time spent awaiting discharge after the acute need for hospitalization has resolved is an important potential contributor to hospital length of stay (LOS). Objective: To measure the prevalence, impact, and context of patients who remain hospitalized for prolonged periods after completion of acute care needs. Design, Setting, and Participants: We conducted a cross-sectional “point-in-time” survey at each of 15 academic US hospitals using a structured data collection tool with on-service acute care medicine attending physicians in fall 2022. Main Outcomes and Measures: Primary outcomes were number and percentage of patients considered “medically ready for discharge” with emphasis on those who had experienced a “major barrier to discharge” (medically ready for discharge for ≥1 week). Estimated LOS attributable to major discharge barriers, contributory discharge needs, and associated hospital characteristics were measured. Results: Of 1928 patients sampled, 35.0% (n = 674) were medically ready for discharge including 9.8% (n = 189) with major discharge barriers. Many patients with major discharge barriers (44.4%; 84/189) had spent a month or longer medically ready for discharge and commonly (84.1%; 159/189) required some form of skilled therapy or daily living support services for discharge. Higher proportions of patients experiencing major discharge barriers were found in public versus private, nonprofit hospitals (12.0% vs. 7.2%; p =.001) and county versus noncounty hospitals (14.5% vs. 8.8%; p =.002). Conclusions: Patients experience major discharge barriers in many US hospitals and spend prolonged time awaiting discharge, often for support needs that may be outside of clinician control.